MEDICARE: EBONY NICOLE HIGHBAUGH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1457986192
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EBONY NICOLE HIGHBAUGH

Provider Business Mailing Address
First Line	:	318 JEFFERSON AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46201-3142
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	318 JEFFERSON AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46201-3142
Country	:	US
Telephone Number	:	317-793-0336
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2020
Last Update Date	:	03/03/2020

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Directions to “ EBONY NICOLE HIGHBAUGH ” Practice Location

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